The patient didnt overdose on medication. She overdosed on grapefruit juice.

The 42-year-old was barely responding when her husband brought her to the emergency room. Her heart rate was slowing, and her blood pressure was falling. Doctors had to insert a breathing tube, and then a pacemaker, to revive her.

They were mystified: The patients husband said she suffered from migraines and was taking a blood pressure drug called verapamil to help prevent the headaches. But blood tests showed she had an alarming amount of the drug in her system, five times the safe level.

Did she overdose? Was she trying to commit suicide? It was only after she recovered that doctors were able to piece the story together.

The culprit was grapefruit juice, said Dr. Unni Pillai, a nephrologist in St....

--snip--

The interaction also can be caused by other citrus fruits, including Seville oranges, limes and pomelos; one published case report has suggested that pomegranate may increase the potency of certain drugs.

Older people may be more vulnerable, because they are more likely to be both taking medications and drinking more grapefruit juice. The bodys ability to cope with drugs also weakens with age, experts say.

Under normal circumstances, the drugs are metabolized in the gastrointestinal tract, and relatively little is absorbed, because an enzyme in the gut called CYP3A4 deactivates them. But grapefruit contains natural chemicals called furanocoumarins, that inhibit the enzyme, and without it the gut absorbs much more of a drug and blood levels rise dramatically.

For example, someone taking simvastatin (brand name Zocor) who also drinks a small 200-milliliter, or 6.7 ounces, glass of grapefruit juice once a day for three days could see blood levels of the drug triple, increasing the risk for rhabdomyolysis, a breakdown of muscle that can cause kidney damage...

I’m not sure if suggesting a smaller amount of medication plus grapefruit juice, as a cost saver, would be a joke or not. I’d guess that the grapefruit juice would have to be pretty well calibrated as well, not just something from the grocery store.

3
posted on 12/18/2012 8:22:03 PM PST
by jiggyboy
(Ten percent of poll respondents are either lying or insane)

Health & science stories like this one is one of the few reasons I check out the NY Times. Most patients are unaware of adverse food and drug interactions, unless it’s printed on the label of the drug container.

This one of those rare everybody on my lists gets pinged, including some medical docs who have identified themselves as such that are not on any list. Comment# 1 has a link to the list of these drugs. From its URL it looks like it was in the Journal of the Canadian Medical Association.

Health & science stories like this one is one of the few reasons I check out the NY Times. Most patients are unaware of adverse food and drug interactions, unless it’s printed on the label of the drug container.

This one of those rare everybody on my lists gets pinged, including some medical docs who have identified themselves as such that are not on any list. Comment# 1 has a link to the list of these drugs. From its URL it looks like it was in the Journal of the Canadian Medical Association.

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. They’d take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

My son emailed a similar story to me last week because he knows I usually slog my small handful of daily vitamins down with grapefruit juice. It never seemed to bother me, but now I wonder if there is any positive or adverse effect on my vitamins (Ester-C cap, B-Complex cap, D gelcap, CoEnzyme Q10 gelcap)?

Certain chemicals that grapefruit products and citrus fruits contain can interfere with the enzymes that break down (metabolize) various medications in your digestive system. As a result, more medication stays in your body. This can increase the potency of your medication to potentially dangerous levels, causing serious side effects.

23
posted on 12/18/2012 9:25:47 PM PST
by Brandonmark
(OWCM is The new American Minority!)

I actually take extra-strength licorice extract while taking my statin (I realize you are not talking about a statin). But the extract is deglycyrrhizinated and it was that part that would cause you problems.

Kidney stones? You have to drink huge amounts of water (or lemonade). My military-Reservist MD put me on his diet, as he suffered from kidney stones as well. How lucky is that to find a doctor with the same ailment? :)

I'm on a successful diet that excludes my favorite foods that started it all.

“Health & science stories like this one is one of the few reasons I check out the NY Times. “

I appreciate your desire to stay up to date on health topics, but I still say “screw the NY Times.”

Go to Drugs.com and either use their drug interaction checker or register with a no-name hotmail account for their mednotes - the latter (if not both) has been showing when grapefruits and grapefruit juice were contraindicated for prescriptions and for OTC medications for years.

The drug, verapamil, featured in the lead, is one I take daily. I’m frightened to hear that it can cause heart block when interacting with grapefruit, but it does indeed prevent vicious migraine attacks.

Thanks, yes I know all about oxalates and I drink so much water I run down the hall all day and night. Have not eaten meat or fowl since 1991, so I do have nuts and soy and beans and milk for protein, but I have lowered my intake of protein. A human being should not have to live without chocolate. :)

42
posted on 12/19/2012 8:01:12 AM PST
by doug from upland
(Obama and the leftists - destroying our country one day at a time)

Thanks. I have taken herbal supplements and for some months I have not had a stone. We will see how long it lasts. When I bowl, I typically bowl 12 games. In two hours, my water intake is now 6+ glasses. I believe I have been so physically active and did not realize I was dehydrating myself.

44
posted on 12/19/2012 8:05:31 AM PST
by doug from upland
(Obama and the leftists - destroying our country one day at a time)

Not a very good idea unless you have a good understanding of what CYP P450 enzyme is responsible for metabolizing the drug you are taking.

If it isn't the one that grapefruit juice inhibits - you will not be taking an effective dose - half the concentration is almost always not half as efficacious - usually it doesn't work at all.

Moreover there is no guarantee that the drug you are taking with grapefruit juice will maintain an efficacious level of the therapeutic long term even if it is metabolized by the correct CPY P450 enzyme - either you will not be taking enough, leading to it not working - or you would be taking too much, leading to a build up of toxic levels.

I think there would be far better avenues to save money than playing with fire drinking grapefruit juice with your medications. You might save money right into the emergency room or the morgue. Death can be a real money saver!

46
posted on 12/19/2012 8:19:13 AM PST
by allmendream
(Tea Party did not send GOP to D.C. to negotiate the terms of our surrender to socialism)

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. Theyd take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

I dont know how much of that is true.

I know personally a friend who does that with Cialis.

He says that 1/4 of a pill works like magic with some grapefruit juice.

Since Cialis is quite expensive, he saves a lot of money that way. It is also a quality of life drug and the effective dose can easily be guessed at safely.

Not that I would know otherwise of course...

I wouldn't recommend this for life saving drugs that you need to stay alive...

49
posted on 12/19/2012 9:42:02 AM PST
by Bon mots
(Abu Ghraib: 47 Times on the front page of the NY Times | Benghazi: 2 Times)

A while back, someone who was a medical transcriber told me, that, grapefruit juice was a trick older folks used with their meds to save money. Theyd take half the dose prescribed with a glass of grapefruit juice. The medical establishment would frown on that because they would lose money... and it would mess up their statistics.

I dont know how much of that is true.

...more on using GF juice with Cialis>>> The standard dose for erectile dysfunction is 20mg., the normal pill dose. However, Cialis is also prescribed for Pulmonary and arterial hypertension, but the recommended dose is 40mg. EVERY DAY! This leads one to believe that there is little risk in trying, say a 5mg dose with grapefruit juice. My friend simply bites the 20 mg. pills into a quarter or third and drinks a whole glass of grapefruit juice. (on an empty stomach, of course.)

50
posted on 12/19/2012 9:49:49 AM PST
by Bon mots
(Abu Ghraib: 47 Times on the front page of the NY Times | Benghazi: 2 Times)

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